When Diane Woodruff was diagnosed with breast cancer in 2011, her primary doctor gave her the names of two physicians to contact about treatment. After doing her research, the 61-year-old Aurora resident chose the doctor who seemed more qualified: the one with the words “breast specialist” in her title.
That physician was Rose Medical Center general surgeon Barbara Schwartzberg, who was about to kick off a clinical trial for an innovative procedure called Intraoperative Radiation Therapy. IORT involves targeting radiation at the site of a tumor, after surgeons remove it, in contrast to standard radiation therapy, which sends X-rays and charged particles throughout the entire breast. The technique has been prominent in Europe for years, but hadn’t been explored much in the United States. Woodruff would be Schwartzberg’s first patient.
Five years later, Rose has one of the largest IORT programs in the country. Schwartzberg has now performed the procedure on hundreds of patients and, armed with their data, is ready to move beyond clinical trials. So many women, including Woodruff, are cancer-free—without undergoing chemotherapy—thanks to this procedure.
Most breast cancer patients have a few treatment options to choose from—each with their own adverse side effects. Mastectomies are a difficult decision for any woman to make. Chemotherapy can cause diarrhea, vomiting, mouth sores, appetite loss, fertility issues, and more. The side effects of radiation are usually less pronounced, yet the treatment often requires daily doses for up to two months.
IORT offers patients an alternative that is quicker and less invasive. Immediately after a surgeon performs the lumpectomy, removing the cancerous tissue, Schwartzberg inserts a balloon-shaped applicator that sends a miniature X-ray into the breast cavity, while a stainless steel shield placed against the patient’s chest protects the heart and lungs from exposure. The patient is under anesthesia throughout the procedure. Traditional radiation therapy attacks the body from the outside, providing a less precise dose that has more potential to damage other organs and miss the cancer cells altogether. “You’re radiating a lot of normal, healthy breast tissue that shouldn’t bear the brunt of [treatment],” Schwartzberg says.
The entire outpatient procedure takes just two hours, while traditional radiation therapy needs to be performed consistently for two or more months. IORT also costs less, as patients are charged based on the size of the area treated. Schwartzberg says some of her patients went back to work the day after their surgery, though she recommends a longer recovery period. Woodruff started working a week and a half post-treatment and says she felt normal again about two months later. She’s now in remission and continues to take an estrogen blocker to help prevent her cancer from coming back. “I feel very grateful that I’m doing as well as I’m doing,” Woodruff says. “I had it easier than a lot of breast cancer patients.”
IORT isn’t for everyone. Schwartzberg cautions patients with tumors that are larger than three centimeters; those whose cancer has spread to their lymph nodes; women who are under the age of 40 or pregnant; and those who have had multiple cancers in their breast are not candidates for this procedure. For those that are eligible, IORT poses a slightly higher risk of recurrence than whole-breast radiation therapy, as well as a small risk of secondary cancer—meaning patients could develop a different kind of cancer as a result of this treatment. (The likelihood of either is rare.)
Schwartzberg credits Rose’s cancer committee and generally collaborative environment for the high quality of life she’s been able to give her patients because of the IORT procedure. In the last five years, her research has evolved from a small, 50-patient clinical trial to examine the safety and efficiency of the technique to being part of a multi-institutional trial that included 1,200 participants from around the world. “We’re really creating a major paradigm shift now with data to back it up and wonderful patients that have stepped up to the plate,” she says.
On October 19, more than 25 IORT patients, including Woodruff, and their families gathered at Rose to celebrate the five-year anniversary of the procedure’s introduction in Denver. The survivors swapped stories, comparing how long ago their surgeries had taken place, and marveled at their results. They were able to share their joy of living through cancer together.